Pathophysiology, Diagnosis and Novel Treatment of Obstructive Lung Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (20 June 2022) | Viewed by 26228

Special Issue Editors


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Guest Editor
1. Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK
2. North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
Interests: respiratory physiology; respiratory mechanics; asthma; lung; pulmonary medicine; airway obstruction; chronic obstructive pulmonary disease; OSA; pulmonary function test; pneumology; sputum; respiratory immunology; exhaled biomarkers
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Guest Editor
Respiratory Diseases, University of Bari, Piazza Giulio Cesare 11, 70121 Bari, Italy
Interests: obstructive lung diseases; airway obstruction; chronic obstructive pulmonary disease (COPD); obstructive sleep apnea; pulmonary medicine; respiration disorders; spirometry; allergic asthma; asthma; allergic diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Even though recent progress of scientific knowledge and the availability of new therapeutic and diagnostic tools have improved the management of obstructive diseases such as asthma and chronic obstructive pulmonary disease (COPD), they remain a foremost public health problem and a challenge for physicians.

As a consequence, asthma and COPD are currently hot topics, as their high prevalence, morbidity, and mortality create many clinical challenges. In this Special Issue, we pursue original research studies and reviews that provide added value to the knowledge of clinicians on the management of asthma and COPD, from epidemiological, diagnostic, and therapeutic points of view, especially on novel treatments. Moreover, we are particularly interested in studies from countries which have not traditionally been represented in the previous publications. We are also keen to receive articles dealing with the pathophysiological pathways connecting asthma and COPD to comorbidities. Human studies and experimental animal and cell culture models are equally encouraged. In addition, aspirant authors are encouraged to submit the results of clinical trials.

Dr. Andras Bikov
Prof. Silvano Dragonieri
Guest Editors

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Keywords

  • asthma
  • COPD
  • obstructive diseases
  • novel treatments

Published Papers (6 papers)

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Editorial

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2 pages, 170 KiB  
Editorial
A Rounded Approach to the Management and Treatment of Obstructive Lung Diseases
by Silvano Dragonieri and Andras Bikov
J. Clin. Med. 2022, 11(14), 4240; https://doi.org/10.3390/jcm11144240 - 21 Jul 2022
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Abstract
Obstructive lung diseases are characterized by obstruction to airflow, inflamed and easily collapsible airways, and difficulties in exhaling, with a socio-economic burden in terms of medical visits and hospitalizations [...] Full article

Research

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13 pages, 908 KiB  
Article
Similarities in Quantitative Computed Tomography Imaging of the Lung in Severe Asthma with Persistent Airflow Limitation and Chronic Obstructive Pulmonary Disease
by Andrzej Obojski, Mateusz Patyk and Urszula Zaleska-Dorobisz
J. Clin. Med. 2021, 10(21), 5058; https://doi.org/10.3390/jcm10215058 - 29 Oct 2021
Cited by 4 | Viewed by 2026
Abstract
Background: Severe asthma with persistent airflow limitation (SA-PAL) and chronic obstructive pulmonary disease (COPD) are characterised by irreversible airflow limitation and the remodelling of the airways. The phenotypes of the diseases overlap and may cause diagnostic and therapeutic concerns. Methods: There were 10 [...] Read more.
Background: Severe asthma with persistent airflow limitation (SA-PAL) and chronic obstructive pulmonary disease (COPD) are characterised by irreversible airflow limitation and the remodelling of the airways. The phenotypes of the diseases overlap and may cause diagnostic and therapeutic concerns. Methods: There were 10 patients with SA-PAL, 11 patients with COPD, and 10 healthy volunteers (HV) enrolled in this study. The patients were examined with a 128-multislice scanner at full inspiration. Measurements were taken from the third to ninth bronchial generations. Results: The thickness of the bronchial wall was greater in the SA-PAL than in the COPD group for most bronchial generations (p < 0.05). The mean lung density was the lowest in the SA-PAL group (−846 HU), followed by the COPD group (−836 HU), with no statistical difference between these two groups. The low-attenuation volume percentage (LAV% < −950 HU) was significantly higher in the SA-PAL group (15.8%) and COPD group (10.4%) compared with the HV group (7%) (p = 0.03). Conclusion: Severe asthma with persistent airflow limitation and COPD become similar with time within the functional and morphological dimensions. Emphysema qualities are present in COPD and in SA-PAL patients. Full article
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14 pages, 2108 KiB  
Article
Is the Power Spectrum of Electromyography Signal a Feasible Tool to Estimate Muscle Fiber Composition in Patients with COPD?
by Antonino Casabona, Maria Stella Valle, Luca Laudani, Claudia Crimi, Cristina Russo, Lucia Malaguarnera, Nunzio Crimi and Matteo Cioni
J. Clin. Med. 2021, 10(17), 3815; https://doi.org/10.3390/jcm10173815 - 25 Aug 2021
Cited by 13 | Viewed by 1902
Abstract
A greater proportion of glycolytic muscle fibers is a manifestation of skeletal muscle dysfunction in Chronic Obstructive Pulmonary Disease (COPD). Here, we propose to use the spectral analysis of the electromyographic signal as a non-invasive approach to investigate the fiber muscle composition in [...] Read more.
A greater proportion of glycolytic muscle fibers is a manifestation of skeletal muscle dysfunction in Chronic Obstructive Pulmonary Disease (COPD). Here, we propose to use the spectral analysis of the electromyographic signal as a non-invasive approach to investigate the fiber muscle composition in COPD. We recorded the electromyographic activity of Rectus Femoris (RF), Vastus Lateralis (VL), Vastus Medialis (VM) and Biceps Femoris (BF) muscles, in ten patients and ten healthy individuals, during non-fatiguing, flexion–extension leg movements. The mean (MNF) and median frequencies (MDF) were calculated, and the most common profiles of electromyographic power spectrum were characterized by using the principal component analysis. Frequency parameters showed higher values in patients with COPD than in the control group for the RF (+25% for MNF; +21% for MNF), VL (+16% for MNF; 16% for MNF) and VM (+22% for MNF; 22% for MNF) muscles during the extension movements and for the BF (+26% for MNF; 34% for MNF) muscle during flexion movements. Spectrum profiles of the COPD patients shifted towards the higher frequencies, and the changes in frequency parameters were correlated with the level of disease severity. This shift of frequencies may indicate an increase in glycolytic muscle fibers in patients with COPD. These results, along with the non-fatigable nature of the motor task and the adoption of a non-invasive method, encourage to use electromyographic spectral analysis for estimating muscle fiber composition in patients with COPD. Full article
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Review

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21 pages, 1106 KiB  
Review
Hypercapnia in COPD: Causes, Consequences, and Therapy
by Balázs Csoma, Maria Rosaria Vulpi, Silvano Dragonieri, Andrew Bentley, Timothy Felton, Zsófia Lázár and Andras Bikov
J. Clin. Med. 2022, 11(11), 3180; https://doi.org/10.3390/jcm11113180 - 2 Jun 2022
Cited by 18 | Viewed by 10250
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that may lead to gas exchange abnormalities, including hypercapnia. Chronic hypercapnia is an independent risk factor of mortality in COPD, leading to epithelial dysfunction and impaired lung immunity. Moreover, chronic hypercapnia affects the [...] Read more.
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that may lead to gas exchange abnormalities, including hypercapnia. Chronic hypercapnia is an independent risk factor of mortality in COPD, leading to epithelial dysfunction and impaired lung immunity. Moreover, chronic hypercapnia affects the cardiovascular physiology, increases the risk of cardiovascular morbidity and mortality, and promotes muscle wasting and musculoskeletal abnormalities. Noninvasive ventilation is a widely used technique to remove carbon dioxide, and several studies have investigated its role in COPD. In the present review, we aim to summarize the causes and effects of chronic hypercapnia in COPD. Furthermore, we discuss the use of domiciliary noninvasive ventilation as a treatment option for hypercapnia while highlighting the controversies within the evidence. Finally, we provide some insightful clinical recommendations and draw attention to possible future research areas. Full article
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18 pages, 1211 KiB  
Review
Early Diagnosis and Real-Time Monitoring of Regional Lung Function Changes to Prevent Chronic Obstructive Pulmonary Disease Progression to Severe Emphysema
by Tony Jung and Neeraj Vij
J. Clin. Med. 2021, 10(24), 5811; https://doi.org/10.3390/jcm10245811 - 12 Dec 2021
Cited by 15 | Viewed by 7458
Abstract
First- and second-hand exposure to smoke or air pollutants is the primary cause of chronic obstructive pulmonary disease (COPD) pathogenesis, where genetic and age-related factors predispose the subject to the initiation and progression of obstructive lung disease. Briefly, airway inflammation, specifically bronchitis, initiates [...] Read more.
First- and second-hand exposure to smoke or air pollutants is the primary cause of chronic obstructive pulmonary disease (COPD) pathogenesis, where genetic and age-related factors predispose the subject to the initiation and progression of obstructive lung disease. Briefly, airway inflammation, specifically bronchitis, initiates the lung disease, leading to difficulty in breathing (dyspnea) and coughing as initial symptoms, followed by air trapping and inhibition of the flow of air into the lungs due to damage to the alveoli (emphysema). In addition, mucus obstruction and impaired lung clearance mechanisms lead to recurring acute exacerbations causing progressive decline in lung function, eventually requiring lung transplant and other lifesaving interventions to prevent mortality. It is noteworthy that COPD is much more common in the population than currently diagnosed, as only 16 million adult Americans were reported to be diagnosed with COPD as of 2018, although an additional 14 million American adults were estimated to be suffering from COPD but undiagnosed by the current standard of care (SOC) diagnostic, namely the spirometry-based pulmonary function test (PFT). Thus, the main issue driving the adverse disease outcome and significant mortality for COPD is lack of timely diagnosis in the early stages of the disease. The current treatment regime for COPD emphysema is most effective when implemented early, on COPD onset, where alleviating symptoms and exacerbations with timely intervention(s) can prevent steep lung function decline(s) and disease progression to severe emphysema. Therefore, the key to efficiently combatting COPD relies on early detection. Thus, it is important to detect early regional pulmonary function and structural changes to monitor modest disease progression for implementing timely interventions and effectively eliminating emphysema progression. Currently, COPD diagnosis involves using techniques such as COPD screening questionnaires, PFT, arterial blood gas analysis, and/or lung imaging, but these modalities are limited in their capability for early diagnosis and real-time disease monitoring of regional lung function changes. Hence, promising emerging techniques, such as X-ray phase contrast, photoacoustic tomography, ultrasound computed tomography, electrical impedance tomography, the forced oscillation technique, and the impulse oscillometry system powered by robust artificial intelligence and machine learning analysis capability are emerging as novel solutions for early detection and real time monitoring of COPD progression for timely intervention. We discuss here the scope, risks, and limitations of current SOC and emerging COPD diagnostics, with perspective on novel diagnostics providing real time regional lung function monitoring, and predicting exacerbation and/or disease onset for prognosis-based timely intervention(s) to limit COPD–emphysema progression. Full article
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Other

21 pages, 10302 KiB  
Systematic Review
A Comprehensive Systematic Review and Meta-Analysis of the Association between the Neutrophil-to-Lymphocyte Ratio and Adverse Outcomes in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
by Angelo Zinellu, Elisabetta Zinellu, Maria Carmina Pau, Ciriaco Carru, Pietro Pirina, Alessandro G. Fois and Arduino A. Mangoni
J. Clin. Med. 2022, 11(12), 3365; https://doi.org/10.3390/jcm11123365 - 11 Jun 2022
Cited by 13 | Viewed by 2552
Abstract
The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission and adverse outcomes [...] Read more.
The neutrophil-to-lymphocyte ratio (NLR) predicts adverse outcomes in stable chronic obstructive pulmonary disease (COPD); however, its prognostic role in acute exacerbations (AECOPD) is less clear. We conducted a systematic review and meta-analysis of the association between the NLR on admission and adverse outcomes (mortality, need for mechanical ventilation, transfer to the intensive care unit, length of stay, pulmonary hypertension, or their combination) in AECOPD by searching PubMed, Web of Science, and Scopus from inception to April 2022. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development, and Evaluation, respectively. In 15 studies (n = 10,038 patients), the NLR was significantly associated with the risk of adverse outcomes (odds ratio = 1.054, 95% CI 1.016 to 1.093, p = 0.005; low certainty of evidence; standard mean difference = 0.82, 95% CI 0.57 to 1.06, p < 0.001; high certainty of evidence). Pooled sensitivity, specificity, and area under the curve were 0.71 (95% CI 0.64 to 0.77), 0.73 (95% CI 0.65 to 0.80), and 0.78 (95% CI 0.74 to 0.81), respectively. In our study, the NLR on admission was significantly associated with adverse outcomes in AECOPD patients, suggesting the potential utility of this biomarker for early risk stratification and management in this group. Full article
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